Adenoid cystic carcinoma of the salivary giands - Tel-Aviv Sourasky ...

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KHAFIF, ANAVI, HAVIV, FIENMESSER, CALDERON, MARSHAK
Table 4. Survival and mortality according
status among the 34 patients
With ACC
Without ACC
Total
Alive
n(%)
1 {2.9}
10(29.4)
11 (32.3)
Died
n (%)
19 (55.9)
4(11.8)
23 (67.7)
to disease
Total
n(%)
20 (58.8)
14 (41.2)
34(100)
our patients, but we cannot draw any conclusions because
ofthe selection bias—that is. patients with more advanced
disease were also treated with radiotherapy. In another
study. Spiro et al' reported that postoperative radiotherapy
conferred no advantage, but others^'' have shown that ACC
is radiosensitive, although not necessarily radiocurable."
Radiation, therefore, might still be of value both in treating
(postoperutively) locally advanced disease and in treating
patients who refuse surgical resection.
As expected, both regional recurrence and distant metastasis
were predictors of poor survival, and aggressive
treatment of recurrences did not have an effect on outcome.
Treatment delivered to the neck should be tailored to the
specific site of origin, as has been proposed by Garden et
al.'" In our series, there was not even I case of regional
recun-ence among the 12 patients with parotid ACC. as
opposed to 11 regional recurrences in the remaining 22
patients (50.0%). We suggest careful evaluation and foilowupexaminations
ofthe neck, including ultrasonography. in
cases of ACC that originate in the minor salivary glands.
Surgery shouldentall lymph node dissection, which can be
limited to the area of maximal drainage; one such option
is supraomohyoid neck dissection for oral cavity tumors.
Again, we emphasize the poor prognosis of our patients
with regional recurrences (survival: 8.3'7^). indicating the
importance of prevention of regional recurrence.
In the specific case of ACC of the submandibular gland,
we recommend surgical excision of the submandibular
triangle as the biopsy procedure. We cannot recommend
elective treatment to the neck for these patients because of
the small number of patients in our study who had primary
disease at that site. Obviously, more studies are needed
to determine the patterns of regional spread in ACC, as
well as the preferred treatment modality and the role of
preventive neck dissections.
Of the 6 patients in our series who received chemotherapy.
I had early-stage disease and survived, and the
other 5 had advanced disease and died of their disease
despite aggressive treatment. Thus, in contrast to findings
reported by Spiroet al,^ we observed no advantage to adding
chemotherapy to tfie treatment protocol for patients with
advanced ACC. Asimilar observation was reported by Hill
et al. who found that the combination of cispiatinum and
5-fluorouracil resulted in no major improvement in survival
ENT-Ear, Nose & Throat Journal • October 2005